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 I I I I I I I I I I I I
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FOURTH CANADIAN EDITION

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PICKAR
PICKAR ABERNETHY
SWART
NEL v

CONTENTS
••
Preface Vil CHAPTER 6
••
About the Authors X11 Interpreting Drug Orders 110
•••
Acknowledgments Xlll Medical Abbreviations 111
•
Using This Book XIV The Drug Order 113
Computerized Medication Administration
Systems 120
MATHEMATICS DIAGNOSTIC EVALUATION 2
CHAPTER 7
SECTION 1 Drug Labels 130
Mathematics Review 7 Trade and Generic Names 130
Dosage Strength 131
CHAPTER 1 Form 132
Fractions and Decimals 7 Drug Delivery Systems 134
Fractions 7 Supply Dosage 134
Decimals 23 Total Volume 135
Administration Route 136
CHAPTER 2
Directions for Mixing or Reconstituting 136
Ratios and Percents 45
Special Instructions 137
Ratios 45
Name of the Manufacturer 139
Percents 46
Expiry Date 139
Percent Measures 50 Lot or Control Numbers 139
CHAPTER 3 Drug Identification Number 140
Systems of Measurement 56 Natural Product Number 141
The International System of Units 56 Bar Code Symbols 141
Alternative Systems of Measurement 60 Unitor Single-Dose Labels 141
Special Classes of Units of Measurement 60 Combination Drugs 142
Time and Temperature Conversions 63 Supply Dosage Expressed as a Ratio or
Percentage 143
CHAPTER 4 Checking Labels 144
Calculation Methods Used in
Determining Drug Dosages 72 SECTION 2 SELF-EVALUATION 154
Method 1: Dimensional Analysis 72
Method 2: Formula 76 SECTION 3
Method 3: Ratio and Proportion 77
Drug Dosage Calculations 158
SECTION 1 SELF-EVALUATION 90
CHAPTER 8
Oral Dosages of Drugs 158
SECTION 2 Tablets and Capsules 160
Measurement Systems, Three-Step Approach to Dosage
Drug Orders, and Calculations 162
Drug Labels 93 Oral Liquids 174

CHAPTER 5 CHAPTER 9
Equipment Used in Dosage Parenteral Dosages Of Drugs 197
Measurement 93 Injectable Solutions 197
Oral Administration 93 High-Alert Parenteral Medications 210
Parenteral Administration 95 Insulin 210
 •
VI Contents NEL

CHAPTER 10 CHAPTER 13
Reconstitution of Solutions 247 Body Surface Area and Advanced
Solution Components 247 Pediatric Calculations 398
Reconstitution of Injectable Medications Body Surface Area Method 398
in Powder Form 249 Syringe Pumps 406
Types of Reconstituted Parenteral Solutions 252 Pediatric Volumetric Control Sets 407
Reconstituted Parenteral Solutions Used Minimal Dilutions for
with Various Routes 258 IV Medications 411
Reconstitution of Noninjectable Solutions 274 Calculation of Daily Volume for
Topical Solutions/Irrigants 275 Maintenance Fluids 413
Oral and Enteral Feedings 276
CHAPTER 14
CHAPTER 11 Advanced Adult Intravenous
Pediatric and Adult Dosages Calculations 424
Based on Body Weight 293 Calculating IV Dosages and Flow Rates
Administering Medications to Children 294 Using Clinical Protocols 424
Converting Pounds to Kilograms 294 Insulin Overdose 439
Body Weight Method for Calculating Critical Care IV Calculations:
Safe Pediatric Dosages 295 Calculating the Flow Rate of an
Combination Drugs 302 IV Medication to be Given Over a
Adult Dosages Based on Body Weight 304 Specified Time Period 443
Body Weight Dosage Calculation 304 Limiting Infusion Volumes 451
SECTION 3 SELF-EVALUATION 328 SECTION 4 SELF-EVALUATION 468

SECTION 4 ESSENTIAL SKILLS EVALUATION 473

Advanced Calculations 341
COMPREHENSIVE SKILLS EVALUATION 489
CHAPTER 12
Intravenous Solutions, Equipment, APPENDIX A
and Calculations 341 Answers 502
IV Solutions 342
Calculating Components of IV Solutions APPENDIX B
when Expressed as a Percent 348 Systems of Measurement 533
IV Sites 350
Monitoring IVs 351 APPENDIX C
Primary And Secondary IVs 351 The Apothecary System of
Blood Administration Tubing 353 Measurement 535
IV Flow Rate 353
Electronically Regulated IVs 355 APPENDIX D
Calculating Flow Rates for Infusion Pumps Household Units, Abbreviations,
In Ml/H 358 and their Equivalents 537
Manually Regulated Ivs 360
Calculating Flow Rates for Manually APPENDIX E
Regulated IVs In Gtt/Min 363 Units of Measurement for
Adjusting IV Flow Rate 371 Temperature 538
Intermittent IV Infusions 377
Calculating IV Infusion Time and Volume 384 Index 541

NEL
PREFACE
Introduction
Dosage Calculations, Fourth Canadian Edition, offers
a clear and concise method of calculating drug
dosages. The text is directed to students and profes-
sionals who want to improve their comfort level with
mathematics, and to faculty members who prefer the
formula method for calculating dosages. The previous
three Canadian and nine U.S. editions have been
classroom tested and reviewed by well over 1 million
faculty and students, who report that this textbook
helped decrease math anxiety and promote confidence
in their ability to perform accurate calculations.
As one reviewer noted, ''I have looked at others
[textbooks J and I don't feel they can compare."
The only math prerequisite is the ability to do basic
arithmetic. For those who need a review, Chapters 1 and
2 offer an overview of basic arithmetic calculations with
extensive exercises for practice.
The text teaches the Three-Step Approach for calcu-
lating dosages:
1. Convert measurements to the same unit;
2. Consider what dosage is reasonable; and
3. Calculate using the formula method.
Dosage Calculations, Fourth Canadian Edition, is
based on feedback from users of the previous editions
and users of other dosage calculation texts. The new
edition also responds to changes in the healthcare sys-
tem by introducing new drugs, replacing outdated
drugs, and discussing new or refined ways of adminis-
tering medications. This revision was designed with the
beginning Canadian healthcare provider in mind. The
International System (SI) of units is used almost ex-
clusively. The medication dosages and drug labels have
been cross-referenced with the current Health Canada
drug database so that beginning professionals will be
able to recognize names and dosages. The importance
of avoiding patient safety incidents, previously referred
to as medication errors, is highlighted by the
incorporation of applied critical thinking skills in
clinical reasoning scenarios based on patient care
situations. New to this edition, examples of National
Council Licensure Examination (NCLEX) test items
are provided at the end of Chapters 5 to 14. These
examples will better prepare graduates for their later
examinations.
••
VII
Organization of Content
This text is organized in a natural progression of basic
to more complex information. Learners gain self-
confidence as they master content in small increments
with ample review and reinforcement. Many learners
claim that because of using this textbook, they over-
came their fear of math for the first time.
Dosage Calculations has 14 chapters, divided into four
sections. At the end of each section is a Self-Evaluation,
which is a test in workbook format with areas for
students to write their answers.
Preceding Section 1 is a Mathematics Diagnostic
Evaluation, which allows learners to determine their
computational strengths and weaknesses. Section 1
then begins. Chapters 1 and 2 provide a review of
basic arithmetic skills, including fractions, decimals,
ratios, percents, and simple equations, with numer-
ous examples and practice problems to ensure that
students can apply the skills. Chapter 3 introduces
systems of measurement with a focus on the metric
system, which is the standard used in the healthcare
field. The household system is included briefly be-
cause of its applications for care at home. Chapter 4
is an overview of the three calculation methods. This
overview is accompanied by numerous examples and
practice problems to ensure that students can apply
the procedures. This section introduces conversion
from one unit of measurement to another. The SI sys-
tem of measurement is emphasized because of its ex-
clusive use in Canada's healthcare sector. However, to
challenge students and prepare them for real life, a
small number of questions require students to con-
vert imperial values to metric. Even though metric is
used in Canada, many individuals still give their
weight in pounds and height in feet and inches, which
require conversion to metric. Questions using impe-
rial values also emphasize attention to detail. The use
of the apothecary and household system is
de-emphasized in the chapters, and additional infor-
mation is provided in the Appendices. The ratio and
proportion method of performing conversions is also
included; however, in this edition, ratio-proportion is
not a major focus because research has shown that
using this approach may be more prone to errors in
calculations. International, or 24-hour, time is
included. Fahrenheit and Celsius temperature
conversions are covered in Appendix D.
 •••
VIII Preface
Section 2 includes Chapters 5 to 7. The information
in this section forms the foundation for measuring drug
dosages and understanding drug orders and labels.
In Chapter 5, users learn to recognize and select
appropriate equipment for the administration of med-
ications based on the drug, dosage, and method of
administration. Emphasis is placed on interpreting
syringe calibrations to ensure that the dosage to be
administered is accurate. All photos and drawings have
been enhanced to improve clarity, and state-of-the-art
technology and information systems have also been
updated.
Chapter 6 presents common abbreviations used in
healthcare so that learners can become proficient in
interpreting medical orders. Generic medication
administration records have been used, as appropriate,
for examples. In addition, the content on computer-
ized medication administration records has been
updated.
It is essential that learners be able to read medica-
tion labels to accurately calculate dosages. This skill is
developed by having readers interpret the medication
labels provided beginning in Chapter 7. These labels
are from current commonly prescribed medications
and are presented in full colour and actual size
wherever possible.
In Section 3, the reader learns and practises the skill
of dosage calculations applied to patients across the life
span. Chapters 8 and 9 guide the reader to apply all the
skills mastered to achieve accurate oral and injectable
drug dosage calculations. Students learn to think
through each problem logically for the right answer
and then to apply a simple formula to double-check
their thinking. Experience has shown that when this
logical but unique system is applied every time to every
problem, math anxiety decreases and accuracy
•
increases.
High-alert medications such as insulin and heparin
sodium are thoroughly presented. Insulin types,
species, and manufacturers have been updated.
Chapter 10 introduces the preparation of therapeu-
tic solutions. Students learn the calculations associated
with diluting solutions and reconstituting injectable
drugs. This chapter leads to intravenous calculations by
fully describing the preparation of solutions. As a result
of the expanding role of the nurse and other healthcare
providers in the home setting, clinical calculations for
home care, such as nutritional feedings, are also
discussed.
Chapter 11 covers the calculation of pediatric and
adult dosages and concentrates on the body weight
method. Emphasis is placed on verifying safe dosages
and applying concepts across the life span.
NEL
Section 4 presents advanced clinical calculations
applicable to both adults and children. Intravenous
administration calculations are presented in Chapters
12 through 14. Coverage reflects the greater applica-
tion of IVs in drug therapy. Shortcut calculation
methods are presented and explained fully. More
infusion devices are included. Heparin and saline
locks, types of IV solutions, IV monitoring, IV ad-
ministration records, and direct IV drugs are
presented in Chapter 12. Pediatric IV calculations are
presented in Chapter 13, and obstetric, heparin
sodium, insulin, and critical care IV calculations are
covered in Chapter 14. Ample problems help students
master the necessary calculations.
Pedagogy
Each chapter begins with Objectives that reflect clear
expectations to help students focus on what they are
expected to achieve once each chapter is completed.
The learning can be readily transferred from the class-
room environment to the workplace environment.
Procedures in the text are introduced using Rule
boxes and Examples.
Key concepts are summarized and highlighted in
Quick Review boxes before each Review Set, to allow
learners an opportunity to review major concepts prior
to working through the problems.
Rationale for Practice boxes identify why a specific
strategy will help solve a problem.
Math Tips provide memory joggers to assist learn-
ers in accurately solving problems.
Learning is reinforced by Practice Problems at the
conclusion of each chapter.
The importance of calculation accuracy and patient
safety is emphasized by patient scenarios that apply
critical thinking skills. Application of Clinical Rea-
soning scenarios have also been added to the end-of-
chapter problem material, to further emphasize accu-
racy and safety.
Information to be memorized is identified in
Remember boxes, and Caution boxes alert learners to
critical procedures and information.
NEW! New to this edition is the addition of an
Understanding NCLEX Questions box near the end of
Chapters 5 to 14. An example of a standard question
used in textbooks is presented with another example of
how the question would look as a NCLEX question.
The solution is also provided.
NEW! Answers to the Review Sets can be found at
the end of each chapter, enabling students to easily
check their work as they progress. Solutions to some of
the Review Sets are also provided there.

NEL
Self-Evaluations at the end of each section provide
learners with an opportunity to test their mastery of
chapter objectives prior to proceeding to the next
section. Two post-tests at the conclusion of the text
evaluate the learner's overall skill in dosage calcula-
tions. The first test, the Essential Skills Evaluation,
covers essential skills commonly tested by employers.
The second post-test, the Comprehensive Skills Evalu-
ation, serves as a comprehensive evaluation of all 14
chapters. Both are presented in a case study format to
simulate actual clinical calculations.
An Answer Key at the back of the text provides all an-
swers as well as selected solutions to Practice Problems,
Self-Evaluations, Essential Skills Evaluation, and the
Comprehensive Skills Evaluation.
Appendix B reviews systems of measurement, in
particular, the SI system. Appendix C describes the
apothecary system of measurement. Appendix D
reviews household units, and Appendix E reviews units
of measurement for temperature and instructions to
convert from one to the other. A general content index
concludes the text.
Note about the Text
The authors have used the Drug Product Database,
Health Canada (www.hc-sc.gc.ca/dhp-mps/prodpharma/
databasdon/index-eng.php ), for the recommended
dosages in this text. There may be some discrepancies
among Health Canada, drug monographs, and the
Compendium ofPharmaceuticals and Specialties (CPS)
in the dosage range requirements for drugs used as
examples in the text. The purpose of this calculations
text is to practise calculations. The authors have tried
to be as accurate as possible; however, it is the
responsibility of the individual administering the drug
to ensure that the dosage administered is safe.
Features of the Fourth
Canadian Edition
• Content is divided into four main sections to help
learners better organize their studies.
• Measurable Objectives at the beginning of each
chapter emphasize the content to be mastered.
• More than 1200 problems reflecting current drugs
and protocols are included for learners to practise
their skills and reinforce their learning.
• Application of Clinical Reasoning skills apply
critical thinking to realistic patient care situations
to emphasize the importance of accurate dosage
calculations and the avoidance of patient safety
incidents.
•
Preface IX
• Full colour is used to make the text more user-
friendly. Chapter elements such as Rules, Rationale
for Practice, Math Tips, Cautions, Remember
boxes, Quick Reviews, NCLEX-style test item ex-
amples, and Examples are colour-coded for easy
recognition and use. Colour also highlights Review
Sets and Practice Problems.
• Most syringes and measuring devices are drawn full
size to provide accurate scale renderings to help
learners master the measurement and reading of
dosages.
• Colour has been added to selected syringe draw-
ings throughout the text to simulate a specific
amount of medication, as indicated in the example
or problem. Because the colour used may not
correspond to the actual colour of the medication
named, it must not be used as a reference for
identifying medications.
• The math review brings learners up to the required
level of basic math competence.
• SI and the conventional metric system notation are
used. (The household system of measurement is
introduced but not emphasized.)
• NEW! Understanding NCLEX questions. An ex-
ample of a standard question used in textbooks is
presented with another example of how the ques-
tion would look as a National Council Licensure
Examination (NCLEX) question. The solution is
also be included.
• Rule boxes draw the learner's attention to pertinent
instructions.
• Rationale for Practice boxes provide the reasoning
for a specific action or decision when calculating
drug dosages.
• Remember boxes highlight information to be
memorized.
• Quick Review boxes summarize critical informa-
tion throughout the chapters before Review Sets
are solved.
• Caution boxes alert learners to critical information
and safety concerns.
• Math Tips point out math shortcuts and reminders.
• Content is presented from simple to complex con-
cepts in small increments fallowed by Review Sets
and chapter Practice Problems for better under-
standing and to reinforce learning.
• Many problems involving the interpretation of
syringe scales are included to ensure that the proper
dosage is administered. Once the dosage is calcu-
lated, the learner is directed to draw an arrow on a
syringe at the proper value.
x Preface
• Canadian labels of current and commonly pre-
scribed medications are included to help users
learn how to select the proper information
required to determine the correct dosage. More
than 200 labels have been used in this text. The
author and publisher have made every effort to
include only labels in use today.
D Cognero® is a secure online testing system that allows
• Numerous Examples demonstrate the H X Q = X
formula method of calculating dosages.
• The dimensional analysis and ratio-proportion meth-
ods are included, giving instructors and students a
choice of which method to use in calculating dosages.
• Abbreviations, measurements, acronyms, and
symbols follow Institution for Safe Medication
Practices (ISMP) Canada's ''Do Not Use'' list.
• Clear instructions are included for calculating IV
medications administered in milligram per kilo-
gram per minute.
• Clinical situations are simulated using actual med-
ication labels, syringes, patient care order forms,
and medication administration records.
• An Essential Skills post-test simulates exams com-
monly administered by employers for new hires,
assesses prior knowledge, and evaluates learning of
essential calculation skills. Comprehensive Skills
evaluates the learner's overall comprehension.
• The general index helps learners and instructors eas-
ily find content and skills.
Instructor Resources
Gl.Dm
~.!Q
NELSONEOUCATKIN TEACHING ADVANTAGE
The Nelson Education Teaching Advantage (NETA)
program delivers research-based instructor resources
that promote student engagement and higher-order
thinking to enable the success of Canadian students
and educators. Visit Nelson's Inspired Instruction
website at nelson.com/inspired/ to find out more
about NETA.
The following instructor resources have been created
for Dosage Calculations, Fourth Canadian Edition.
Access these ultimate tools for customizing lectures and
presentations at nelson.com/instructor.
NETA Test Bank
This resource was written by Myrna Michelle Davis,
Red River College. It includes over 250 multiple-
choice questions written according to NETA
NEL
guidelines for effective construction and develop-
ment of higher-order questions.
- ®
cog FUii-Circie Assessment•
The NETA Test Bank is available in a new, cloud-
based platform. Nelson Testing Powered by
instructors to author, edit, and manage test bank
content from anywhere Internet access is available.
No special installations or downloads are needed, and
the desktop-inspired interface, with its drop-down
menus and familiar, intuitive tools, allows instructors
to create and manage tests with ease. Multiple test
versions can be created in an instant, and content can
be imported or exported into other systems. Tests can
be delivered from a learning management system, the
classroom, or wherever an instructor chooses. Nelson
Testing Powered by Cognero for Dosage Calculations,
Fourth Canadian Edition, can be accessed through
nelson.com/instructor.
NETA PowerPoint
Microsoft® PowerPoint® lecture slides for every
chapter have been created by textbook author Beth
Swart, Ryerson University. There is an average of 15
slides per chapter, many featuring key figures, labels,
tables, and photographs from Dosage Calculations,
Fourth Canadian Edition. NETA principles of clear
design and engaging content have been incorporated
throughout, making it simple for instructors to cus-
tomize the deck for their courses.
Image Library
This resource consists of digital copies of figures,
tables, photographs, and drug labels used in the
book, in a version with and without labels.
Instructors may use these jpegs to customize the
NETA PowerPoint or to create their own PowerPoint
presentations. An Image Library Key further lists the
description and filename of each jpeg.
Instructor's Solutions Manual
This manual, prepared by author Beth Swart, has
been independently checked for accuracy by Heather
LeBlanc, Oulton College. It contains complete solu-
tions to Review Sets, Practice Problems, Essential
Skills Evaluation, and the Comprehensive Skills
Evaluation. It also includes suggested answers for the
Application of Clinical Reasoning problems.

NEL
MindTap
.. ,#
~
Offering personalized paths
MINDTAP of dynamic assignments and
·- applications, MindTap is a
digital learning solution that turns cookie-cutter into
cutting-edge, apathy into engagement, and memoriz-
ers into higher-level thinkers. MindTap enables stu-
dents to analyze and apply chapter concepts within
relevant assignments, and allows instructors to mea-
sure skills and promote better outcomes with ease. A
fully online learning solution, MindTap combines all
student learning tools readings, multimedia, activi-
ties, and assessments into a single Learning Path
that guides the student through the curriculum.
Instructors personalize the experience by customizing
the presentation of these learning tools to their stu-
dents, even seamlessly introducing their own content
into the Learning Path.
Student Ancillaries
MindTap
.. ,# MINDTAP
~ Stay organized and efficient
·- with MindTap-a single des-
tination with all the course
•
Preface XI
material and study aids you need to succeed. Built-in
apps leverage social media and the latest learning tech-
nology. For example:
• ReadSpeaker will read the text to you.
• Flashcards are pre-populated to provide you with a
jump start for review or you can create your own.
• You can highlight text and make notes in your
MindTap Reader. Your notes will flow into Ever-
note, the electronic notebook app that you can ac-
cess anywhere when it's time to study for the exam.
• Quizzes allows you to asses your understanding,
and some include a ''practice'' syringe with a
plunger that can be manipulated. Quizzes have
been written and checked by Heather LeBlanc, Oul-
ton College.
• Chapter tutorials outline instructions and ap-
proaches to safe and accurate dosage calculation.
Tutorials have been checked and updated by
Heather LeBlanc, Oulton College.
Visit www.nelson.com/student to start using
MindTap. Enter the Online Access Code from the
card included with your text. If a code card is not
provided, you can purchase instant access at
NELSONbrain.com.
 ••
XII NEL

ABOUT THE AUTHORS

Gloria D. Pickar, R.N., Ed.D.
Gloria D. Pickar, R.N ., Ed.D., is Group President and Chief Academic Officer of EmbanetCompass in
Orlando, Florida. She is a former Academic Dean at Seminole State College in Sanford, Florida. She
is also the author of nine editions of best-selling Dosage Calculations.

Amy Pickar Abernethy, M.D.

Amy Pickar Abernethy, M.D., is Associate Professor of Medicine and Nursing at Duke University in
Durham, North Carolina.

Beth Swart, R.N., M.E.S.

Beth Swart, R.N ., M.E.S., is a professor at the Daphne Cockwell School of Nursing, Ryerson
University, Toronto. She received her diploma of nursing from the Hospital for Sick Children School
of Nursing, her B.Sc.N. from the University of Toronto, and her M.E.S. from York University. Beth has
taught nursing for more than 40 years, at the diploma level and the baccalaureate level. She is a men-
tor to students as well as to faculty and instructors. Her areas of expertise are epidemiology and
pathophysiology. Beth has also developed innovative online courses using a variety of teaching strate-
gies and technology. Consequently, her major interests are in learning strategies and outcomes. She
has been recognized for her teaching excellence. Beth has been an author for Nelson for many years,
and has also authored numerous other publications as well.
 •••
NEL XIII

ACKNOWLEDGMENTS

Reviewers Technical Accuracy Check

We wish to thank our many students and colleagues Special thanks to Heather LeBlanc, B.Sc. CCPE, RPhT,
who have provided inspiration and made contribu- Lead Instructor, Pharmacy Technician Program, Fac-
tions to the production of the text. We would also like ulty of Health Science, Oulton College, who checked
to thank the following reviewers for their insight and the accuracy of the dosage calculations and suggested
suggestions during the development of this edition: clarifications and corrections wherever applicable in
the text and the solutions.
Christine Boyle
Mount Royal University
Lucille Canart
Red River College
Dwayne Pettyjohn
Camosun College
Cindy Skolud
Seneca College of Applied Arts and Technology
Barbara Thompson
Sault College
Diane Valiquette
Bow Valley College
 •
XIV NEL

USING THIS BOOK • • •

• Concepts are presented from simple to complex, Example:

in small increments, followed by Quick Review 2 3

- and - and -
7
3 8 24
boxes to reinforce learning.
i
The LCD is 24. is the equivalent of~; i is the equivalent of~· Therefore, the largest fraction is
2 or 16 ; the smaII est f ract1on
. 1.s 7 .
3 24 24

QUICK REVIEW

• Proper fraction: numerator is less than denominator: value is less th an 1. Example: ~

• Improper fraction: numerator is greater than or equal to denominator; value is greater th an 1.
Example: ; Or numerator = denominator; value = 1. Example: ~
• Mixed number: whole number + a fraction; value is greater th an 1. Example: 1 ~
• Complex fraction: numerator and/or denominator composed of fractions; value is greater than.
1
less than. or = 1. Example: f
50

• Review Sets are inserted after each new

REVIEW SET 12

Use the dimensional analysis n1ethod to convert each of the following to the equivalent indicated.
topic to encourage learners to stop and
1. 500 1nL = L 14. 2 kg = g check their understanding of the material
2. 0.015g= mg 15. 5000 mL = L just presented. Answers to these are available
3. 8mg = g 16. 1 L = mL
at the end of the chapter. Solutions to
4. lOmg = g 17. 1 g = mg
5. 60mg = 18. 1 mL =
selected Review Set items are also available
g L
6. 300 mg = g 19. 23 1ncg = 1ng there.

• Practice Problems round out each chapter. This

PRACTICE PROBLEMS-CHAPTER 5
is the students' opportunity to put their skills to 1. In the 100-unit insulin syringe, 100 units = rnL.

the test, to identify their areas of strength and 2. The 1-rnL syringe is calibrated in of a mL.
3. Can you rneasure 1.25 mL in a single tuberculin syringe? _ _ _ Explain. _ _ _ __
the areas in which they need additional study.
Answers to these are provided at the end of the
book, in the Answers section. Solutions to some 4. Ho"' v1ould you ,neasure 1.33 mL in a 3-rnL syringe? - - - - - - - - - - - -

Practice Problems are also provided there.

Visuals
• Photos and drug labels are presented in full colour to DIN 02382296
help students prepare themselves in practice.
Heparin Sodium
Injection USP
10 000 units/10mL
1 000 units/ml Heparin u
-...c
For intravenous or subcutaneous Use Only. (I)

INOT for Lock Flush I ~

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Warning: Contains Benzyt Alcohol 0
>,
Sterile "'
• lnjectab/es ~:::,
25 x 10 ml Multidose vials
0
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NEL Using This Book xv

• Syringes are drawn full size in most in- 14. Administer 1.3 mL.

stances, to provide accurate scale render-

ings to help learners master the reading of ............ N M

injectable dosages.
15. Adn1inister 0.33 mL.

'
..
- ......
"' •
M
•
o::t"• It)
•
<O• ,.... co
• •
(;)-..J
en• ,.....• E

16. Administer 65 units of 100-unit insulin.

USE 1OO·UNIT ONLY

10 10 10 10 10 10 10 10 10 10 (Opposite Side)
....- CN C'? - 10 CD r- CO O'>

• Illustrations simulate critical dosage calculations

and dose preparation skills. In particular, colour 100-unit
' -';';-
Novo lin" - 1
-:c
100-unit
Novolin
ge Toronto ge NPH
is used to simulate a specific amount of
medication.

'

Pen Body
!IN
'g
l,s
! ..
5

Dose t
21
Insulin Reservoir W indow ,. t, c: c:
~

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• Math Tip boxes provide clues to MATH TIP

essential computations, math
shortcuts, and reminders Incorrect placement of units of measurement can resu lt in an incorrect answer. Even when
calculating with dimensional analysis, thinking and reasoning are essential.
throughout the text.

• Caution boxes alert learners to CAUTION

critical information and
Whenever a decimal fraction (whose value is less than 1) is written in medical notations, the
safety concerns. zero MUST precede the decimal point. This practice highlights the decimal point and the fact
that the value of the number is less than 1.
 •
XVI Using This Book NEL

RULE • Rule boxes highlight and draw

! attention to important formulas
A Step3 Calculate
D
Apply the dosage calculation formula: H x Q = X and pertinent instructions.

• Remember boxes highlight REMEMBER

information that learners should
•
memorize. - '
- To avoid confusion ,
• Always use the capitalized L to indicate litre. The lower case I is easily confused with the
number one (1 );
• Always use mcg to indicate microgram. The µ symbol is easily misunderstood.

QUICK REVIEW • Quick Review boxes summarize

.L critical information that students
1 It • Percent (Part) = Percent X Whole Quantity
need to know before the Review
Example: What is 15% of 48?
Sets are solved.
15
15 o/o X 48 = X 48
100
3
15 J..6
12 3 36
= X.48 = -X12 = -X12=-=7.2
.WO 25 5 5
25 5

• Rationale for Practice boxes

provide the reasoning for a •. •
• Some syringes may still be marked in cubic centimetres Ccc) ; however, most drugs are
specific action or decision. prepared and labelled with the strength given per millil itre Cml). The cubic centimetre and
millilitre are equivalent measurements in dosage calculations (1 cc = 1 ml).

UNDERSTANDING NCLEX QUESTIONS • NEW! New to this edition is the

addition of an Understanding
Here's an example of a standard question used in textbooks:
NCLEX Questions box near the
Four-year-old Peter is ordered an oral liquid drug suspension of 4 ml per dose. The best
way to administer this medication would be to use a/ an:
end of Chapters 5 to 14. An
a. household teaspoon example of a standard question
b. cooking measuring spoon used in textbooks is presented
c. oral syringe
d. graduated medicine cup with another example of how the
Here's how it would look in an NCLEX examination:
question would look as a NCLEX
question. The solution is also
The nurse is to discharge a 4-year-old home on an oral liquid drug suspension of 4 ml per
dose. Which would the nurse recommend to ensure the highest level of accuracy in home provided.
administration of the medication?
a. Using a household teaspoon
b. U sing a cooking measuring spoon
c. Using an oral syringe
d. Using a graduated medicine cup

Answer: c. Using an oral syringe

Rationale: The oral syringe would provide the most accurate dose of 4 ml.
 ••
NEL Using This Book XVII

• Application of Clinical Ooo APPLICATION OF CLINICAL REASONING

Reasoning skills are ap-
Potential Patient Safety Incident
plied to realistic patient
care situations to empha- Incorrect interpretation of order due to misunderstanding of traditional time.

size the importance of Possible Scenario

accurate dosage calcula-
tions and avoiding patient
safety incidents. As an
added benefit, clinical
• •
reasoning scenarios
present prevention strate-
gies so that the student
can learn how to avoid
these patient safety inci-
dents in practice.
A physician prescribed a mild sedative for a patient who is anxious and is scheduled for a
sigmoidoscopy in the morning. The order read diazepam 5 mg orally at 6:00 X 1dose. The
evening nurse might have assumed that the physician intended this medication to reduce the
patient's anxiety and aid him in sleeping the night before the procedure. However. the nurse
knew that sleeping aids are usually administered at bedtime. not at the time of evening
preparations. The nurse used clin ical reasoning and contacted the physician to clarify the
order. The physician said she meant for the diazepam to be given at 6 o'clock AM to help the
patient relax prior to the actual test.
Potential Outcome
Diazepam would help the patient relax during the sigmoidoscopy and make him drowsy. It is
not desirable for the patient to be drowsy or sedated during the evening preparations. Because
of the omission of the AM designation, the patient would lose any benefit from the sedative at
the intended time if the medication had been administered the evening before the test. The
patient would have likely experienced unnecessary anxiety both before and during the test.

Prevention
This scenario emphasizes the benefit of the 24-hour clock. If international time had been in use
at this facility, the order would have been written as diazepam 5 mg orally at 0600 X 1dose,
clearly indicating the exact time of administration, reducing the risk of a patient safety incident.
Application of Critical Reasoning Additional application problems are provided at the end of the chapter.
Answers are provided at the end of the book.

Additional Self-Assessment
Mathematics Diagnostic Evaluation: The Mathemat-
ics Diagnostic Evaluation, a mini-chapter that precedes
Section l, allows learners to identify their computa-
tional strengths and weaknesses.
Self-Evaluation: Self-Evaluations at the end of each
section provide learners with an opportunity to test
their mastery of chapter objectives prior to proceed-
ing to the next section.
Post-tests: Two tests at the end of the text evaluate the
learner's overall skill in dosage calculations. The first
test, Essential Skills Evaluation, covers essential skills
commonly tested by employers. The second test is a
Comprehensive Skills Evaluation.
Answer Key: At the end of the text is an answer key
with selected solutions to Practice Problems, section
Self-Evaluations, and post-tests.
FOURTH CANADIAN EDITION
 To prepare for calculating dosages, it is important to know how to add, subtract, multiply, and divide
whole numbers. It is also important to have a working knowledge of fractions, decimals, ratios, per-
cents, and basic problem solving. This text reviews these important mathematical operations, which
support all dosage calculations in healthcare.
Set aside 11 hours in a quiet place to complete the 50 items in the following diagnostic evaluation.
Use a notepad and a pencil to work the problems.
Use the results to determine your current computational strengths and weaknesses and to guide
your review. A minimum score of 86 is recommended as an indicator of readiness for dosage calcu-
lations. If you achieve that score, you may proceed directly to Chapter 3. However, note any prob-
lems that are answered incorrectly, and use the related review materials in Chapters 1 and 2 to refresh
your arithmetic skills.
This mathematics diagnostic evaluation and the review that follows are provided to enhance con-
fidence and proficiency in arithmetic skills, thereby helping students avoid careless mistakes later when
you perform dosage calculations.
Good luck!

Directions:
1. Carry answers to three decimal places and round to two decimal places.
(Examples: 5.175 = 5.18; 5.174 = 5.17)
2. Express fractions in their lowest terms.
6 3
(Example: = )
10 5

Mathematics Diagnostic Evaluation

1. 1517 + 0.63 =

2. Express the value of 0.7 + 0.035 + 20.006 rounded to two decimal places.
3. 9.5 + 17.06 + 32 + 41.11 + 0.99 =

4. $19.69 + $304.03 =

5. 93.2 - 47 .09 =

6. 1005 - 250.5 =

7. Express the value of 17.156 - 0.25 rounded to two decimal places.

8. 509 X 38.3 =

9. $4.12 X 42 =

10. 17.16 X 23.5 =

11. 972 7 27 =

12. 2.5 7 0.001 =

2 NEL
NEL Mathematics Diagnostic Evaluation 3

1
13. Express the value of - -=- I as a fraction reduced to its lowest terms.
4 8
1500 .
14. Express as a decimal.
240
15. Express 0.8 as a fraction.
2
16. Express as a percent.
5
17. Express 0.004 as a percent.
18. Express 5o/o as a decimal.

1 . . 1
19. Express 33- o/o as a ratio in owest terms.
3
20. Express 1:50 as a decimal.

1 3
21. - + - =
2 4
2 7
22. 1- + 4- =
3 8

5 2
23. 1- - - =
6 9

24. Express the value of ~ X 60 as a fraction.

1 0

25. Express the value of 4_!__ X 3_!__ as a mixed number.

4 2
1 1 1
26. Identify the fraction with the greatest value: , ,
150 200 100
27. Identify the decimal with the least value: 0.009, 0.19, 0.9

6.4
28.
0.02

0.02 + 0.16
29.
0.4 - 0.34
3
30. Express the value of X 0.25 as a decimal.
12 + 3
31. 8o/o of 50 =

1
32. -o/o of 18 =
2

33. 0.9o/o of 24 =

Find the value of ''X. '' Express your answer as a decimal.

1:1000
34. X 250 = X
1:100
4 Mathematics Diagnostic Evaluation NEL

300
35. X2 = X
150
2.5
36. X 1.5 = X
5
1000 000
37. XX= 12
250000
0.51
38. XX= 150
1.7
3
39. X = (82.4 - 52)-
5
1
40. l~O x 1.2 = x
300

41. Express 2: 10 as a fraction in its lowest terms.

42. Express 2°/o as a ratio in its lowest terms.
43. If 5 equal medication containers contain 25 tablets in total, how many
tablets are in each container?
44. A patient is receiving 0.5 milligrams of a medication 4 times a day.
What is the total amount of medication in milligrams given each day?
45. If 1 kilogram equals 2.2 pounds, how many kilograms does a 66-pound
child weigh?
46. If 1 kilogram equals 2.2 pounds, how many pounds are in 1.5 kilograms?
(Express your answer as a decimal.)

47. If 1 centimetre equals~ inch, how many centimetres are in 2i inches?

(Express your answer as a decimal.)
48. If 2.5 centimetres equal 1 inch, how long in centimetres is a 3-inch wound?
49. This diagnostic test has a total of 50 problems. If you incorrectly answer
5 problems, what percentage will be answered correctly?
50. For every 5 female student nurses in a nursing class, there is 1 male
student nurse. What is the ratio of female to male student nurses?

Check your work! Answers to these questions are provided next, as well as solutions to some of the questions.
Give yourself 2 points for each correct answer.

Perfect score = 100 My score = ____

Readiness score = 86 ( 43 correct)
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 Chapter II

The Guinea Pigs’ Rest

In front of the inn, leaning comfortably back in his

chair, with his feet up against the door post, sat a fat,
black and white guinea pig. When Nibbles went up to
ask him if he could have some dinner, he saw that
Mr. Guinea Pig was fast asleep, and snoring loudly.

“It is a pity to wake him,” thought Nibbles, “but I

am awfully hungry; and besides, his mouth is so wide
open that he might easily swallow a wasp.”
 Nibbles coughed, and then he whistled, but the
Guinea Pig never stirred. Finally, in desperation,
Nibbles got a straw, and began to tickle his nose.
First Mr. Guinea Pig twitched his nose, then he
opened one eye; at last he gave such a tremendous
sneeze that he nearly fell out of his chair, and with a
snort he woke up.

“Hullo!” said he angrily. “What do you want? This

is the third time this morning that I have been waked
up, and I’m sleepy and want my nap.”
 “Excuse me,” answered Nibbles timidly, “but I am
very hungry, and should like to have some dinner.”

“Well, go into the house and get the Salamander,”

growled Mr. Guinea Pig. And before Nibbles could
ask another question, he was sound asleep again,
and snoring away as hard as ever.

“I wonder what the Salamander is?” thought

Nibbles. “It sounds like a sandwich or a salad. The
thing is to find it.”

As Mr. Guinea Pig completely blocked the front

doorway, Nibbles had to hunt about until he at last
found another entrance. Then he wandered down a
long hall with empty rooms on either side, but no
Salamander could he find.

Finally he heard a squeaking and a squealing,

which seemed to come from a room at the end of the
hall. He knocked gently on the door, but, as no one
answered, he ventured to peep in.

A bright fire was burning in the fireplace, in spite

of its being a summer day, so the room felt very hot.
 On a footstool in front of the fire, sat two tiny
guinea pigs, who had evidently just been washed,
and were now being dried. Their hair had been
carefully curled, and each had a blue ribbon tied
around its neck in a big bow.

Mrs. Guinea Pig held on her lap a third little pig,

whose hair she was curling, while the littlest piggy of
all was sitting in the bathtub.

“I beg your pardon,” said Nibbles politely, “but can

you please tell me where I can find the Salamander?”
 Mrs. Guinea Pig, whose back was to the door,
gave such a jump that she nearly dropped the little
pig.
“Oh, come right in,” she said pleasantly, when she
saw Nibbles. “I am delighted to see you, only please
close the door, as I don’t like a draft.”

Nibbles thought a draft of fresh air was very much

needed, but he said nothing, and closed the door.

“You will find the Salamander in the kitchen,” said

Mrs. Guinea Pig. “He ought to be cooking the dinner,
but he probably is asleep, as the heat from the stove
seems to go to his head.”

Just then there was a

sudden splash and a loud
squeal. While Mrs. Guinea
Pig had been talking to
Nibbles, one of the little pigs
had jumped off the footstool,
and had come over to see
what the littlest piggy was
doing. He had climbed up on the edge of the tub, and
then had slipped, and fallen into the water, right on
top of the baby.
Mrs. Guinea Pig was very angry with the naughty
little pig for being disobedient, and also for spoiling
its best blue bow. While she was giving him a
shaking, the piggy on her lap fell onto the floor, and
then there was such a squeaking and a squealing
that Nibbles ran out of the room, without even waiting
to say good-bye.
 Chapter III

The Salamander

Nibbles was sorry that he had not asked where the

kitchen was, but he preferred to hunt it up himself
rather than to go back to Mrs. Guinea Pig’s hot bath-
room, and after a little while he found it.

The tea-kettle was boiling cheerily on the stove,

and Nibbles noticed a delicious odor of toasted
cheese and bacon, but nowhere could he see the
Salamander.

He looked in the cupboard and under the sink,

behind the door and under the table, in the coalhod
and behind the stove, until at last, being very hungry,
 he began to call: “Mr.
Salamander! Oh, Mr.
Salamander!”
At once he heard a sleepy,
squeaky voice saying: “Yes,
yes, I’ll get up in a minute. Is
it time for breakfast already?”

The voice came from the

stove, and, to Nibbles’s
amazement, he saw the oven
door slowly open, and the most curious looking
animal with a very sleepy face jump out. It looked like
a fat black lizard, with large flame-color spots, bright
black eyes, and queer, short little legs.
 After giving such a prodigious yawn that Nibbles
was afraid that he might never be able to shut his
mouth again, he looked at Nibbles and said very
sadly: “Oh, dear! I was having such a lovely dream
when you woke me up.”

“I am very sorry,” replied Nibbles, “but I am so

hungry that I shall soon be ready to eat my
whiskers.”

“Well, well,” said the Salamander, “you sha’n’t wait

another minute”; and he bustled about so fast that,
before he knew it, Nibbles was eating large quantities
of cheese and bacon pie, and drinking cups of tea so
hot that it made him wink.

Meanwhile, the Salamander had climbed up on

top of the stove, where he sat with his feet hanging
over the edge, nodding and dozing.
 “Do you never get too hot?” inquired Nibbles.

“Oh, no,” replied the Salamander. “I belong to a

very chilly family. We are all devoted to heat and
poetry. Would you like to hear my favorite poem?”

“Yes, very much,” said Nibbles.

 So the Salamander, in a high, squeaky voice,
began to recite:

“The Salamander loves to sit

Upon the red-hot stove,
And longs to clasp it in his arms,
Wherever he may rove.

“He likes the little scarlet flames

That sparkle in the fire,
And in a boiling tea-kettle
Sees something to admire.

“Do you remember what comes next?” he inquired

anxiously. “I am afraid that I have forgotten.”

“No,” said Nibbles. “I am very fond of singing, but I

don’t know any poetry.”

“Well,” yawned the Salamander, “in that case, I

think, if you don’t mind, that I’ll take another nap.
Poetry always makes me very sleepy.”

Then, curling his short little arms around the tea-

kettle, and resting his head so near the spout that
Nibbles was afraid the steam would blow it off, he
began once more to recite very drowsily.
 By this time Nibbles had eaten all that he possibly
could, so he said good-bye to the Salamander, who
paid no attention, and started off again.
As he trotted briskly down the hall, he could still
hear the Salamander murmuring sleepily to himself:
“He—​likes—​the—​lit—tle—​scar—let——​flames——​
which——” and then nothing more; so he must have
gone fast asleep.
 Chapter IV

The Terrible Cat

Nibbles spent the night in a cosy nest which he

found in a hazel bush, and early the next morning he
was off once more on his travels.

Towards noon, while he was picking acorns for

dinner, whom should he see, running along the road,
but his cousin, Teenie Weenie, the dearest little white
mouse in the world?
 “Hullo, Teenie Weenie!” called Nibbles. “Where did
you come from?”

“Why, I live in a village not far from here,” replied

Teenie Weenie. “And where are you going, Cousin
Nibbles?”

“I am going to seek my fortune,” said Nibbles.

“Oh, do let me come, too,” begged Teenie.

“All right, come along,” answered Nibbles. “Two is

company and one is none. Only don’t keep getting
tired.”

“No, I certainly won’t,” promised Teenie. “But you

must come and have supper at my house before we
start.”
 By the time they reached the village, it was dark,
and the lights in the houses were beginning to shine.
They crept cautiously down the street until they came
to a pretty house in the middle of a large garden.
 “That is where I live,” said Teenie Weenie, “but
look out for the Cat.”